This past week the Nevada State Athletic Commission issued pro MMA fighter Jessica Rakoczy a fine and suspension – and also overturned her recent win – for failing a post-fight drug test.

Her offense? Taking a painkiller for back pain and not alerting officials.

In his latest installment of “Ask the Fight Doc,” MMAjunkie.com medical columnist Dr. Johnny Benjamin explains why commissions must take a hard stance against all banned substances, even in cases such as Rakoczy’s in which the fighter wasn’t trying to cheat.

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Doc: Do you think that Jessica Rakoczy should have been suspended by the NSAC for taking a Percocet for back pain? How is that a performance-enhancing drug? – Anonymous

It is a bit surprising how many times I receive some variation of this question, though it usually involves marijuana use. It is a great question, and the answer is more complex than may appear at face value.

Let me remind you: Substances that some may consider performance-enhancing drugs (PEDs) are just one category included in the official banned-substances list. Anabolic steroids get all of the publicity but, in fact, are just one aspect of the overall testing spectrum.

Many substances appear on the list not for their performance-enhancing potential but for participants’ safety. Many fans get lost in the debate of whether narcotic pain relievers are PEDs or not. The more relevant question is this: Is it safe to compete in a combat sport with that substance in your system?

Some say that training and sparring injure fighters and that they should be allowed something (i.e. pain meds) to compete with all of their dings. Others argue that painkillers allow fighters to absorb and tolerate more punishment than they would have otherwise, and therefore, it provides an unfair advantage.

As in many discussions, there is probably some truth to both arguments. But let’s look at this from a different perspective.

As any busy ER physician or trauma-related surgeon will attest, it is difficult to properly, quickly and accurately assess a trauma patient who appears on your doorstep with drugs, including alcohol, on board. Is the patient unresponsive or mentally altered because of the trauma – or because of the drugs? Or both?

As an FYI, common side effects of narcotic painkillers include drowsiness, decreased cognition (ability to clearly think and respond appropriately), slowed reflexes, poor balance and nausea. These all happen to be characteristics of head trauma/brain injury, as well.

Fortunately, at properly equipped trauma facilities, we have the latest in diagnostic equipment (MRIs, CT, digital X-ray, etc.), dependable tests and the help of a properly trained, highly specialized team. In the ring or cage, the physician has virtually no assistance other than his or her training and years of experience. Don’t forget; this all plays out in front of thousands of screaming fans and possibly a television audience, as well.

I will suggest that this is the wrong time for the ringside physician to attempt to determine if the changes that he or she is seeing in fighters’ behavior and/or performance are related to potential head trauma/brain injury or if they merely took a painkiller for a bad back.

How do we (interested/involved physicians and state athletic commissions) protect an athlete who may enter the ring impaired by a painkiller (that we know nothing about), and how do we quickly, accurately and properly assess that person when he or she get stretched out or pummeled by an effective ground and pound?

Should the fighter in question be fined and suspended? Yup.

Should there be exceptions to the rules on banned substances? Nope.

Should the list of banned substance be changed? Currently, it’s not for me to decide.

Dr. Johnny Benjamin is MMAjunkie.com’s medical columnist and consultant and a noted combat-sports specialist. He is also a member of the Association of Boxing Commissions’ MMA Medical Subcommittee. Dr. Benjamin writes an “Ask the Doc” column every two weeks for MMAjunkie.com. To submit a question for a future column, email him at askthedoc [AT] mmajunkie.com, or share your questions and thoughts in the comments section below. You can find Dr. Benjamin online at www.drjohnnybenjamin.com, and you can read his other sports-related articles at blog.drjohnnybenjamin.com.

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